Circulatory dynamics during dental extractions in normal, cardiac and transplant patients

The authors conducted a study to evaluate the relationship between the circulatory dynamics of patients with heart disease and these patients' cardiac status when undergoing dental extractions.

Subjects with minimal heart disease, or MHD; with severe heart disease, or SHD; or who received a heart transplant, or TRAN; as well as control, or NOR, subjects were enrolled in the study. The authors recorded subjects' systolic blood pressure, or SBP; diastolic blood pressure, or DBP; and heart rate, or HR, while they were under basal conditions and during postanesthesia and dental extraction periods. The authors estimated a general linear model and performed analysis of variance.

Under basal conditions, MHD subjects did not show significantly different mean blood pressure values compared with NOR subjects but did show slightly significantly higher mean HR values. Mean DBP and HR values were significantly higher in SHD and TRAN subjects than in MHD and NOR subjects, while SBP values in SHD subjects were significantly lower than those in MHD, TRAN and NOR subjects. During dental extraction sessions, SBP, DBP and HR mean values increased significantly compared with basal conditions and post-anesthesia periods in MHD and NOR subjects. SHD and TRAN subjects showed no significant time-dependent variation during dental extraction sessions in any circulatory parameter.

MHD subjects had cardiovascular responses to stress similar to those of NOR subjects, while SHD and TRAN subjects had similar slight and dulled cardiac responses.

Patients with SHD may not be able to adapt their cardiac performance to an emotional stress such as a dental appointment, while it seems to be easier for MHD and TRAN patients. Managing TRAN patients is relatively easier than managing SHD patients.